Finding supportive doctors and insurance providers can be a challengeby Eli Winter

A transgender woman breaks her leg and goes to the emergency room for treatment. When she arrives at the ER, doctors tell her they don’t treat “her kind.”

A gender-diverse child is allowed to socially transition genders to reflect her gender identity. Their family doctor reports the parents to CPS.

A lesbian woman is tested for cervical cancer. When discussing the results of the test, her doctor assumes she is heterosexual.

Although these scenarios may seem like cherries picked off of a small sapling of LGBT healthcare discrimination, they can more accurately be compared to acorns from an enormous oak tree. Discrimination against LGBT people in healthcare settings remains frequent and pervasive, even as societal attitudes toward the health of LGBT people become more positive.

For most of the 20th century, homosexuality was classified as an illness by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders. The manual’s description of homosexuality reflected the usual misconceptions about lesbian and gay people, and descriptions of healthy, satisfied lesbian and gay Americans were, of course, not included. The association removed homosexuality from the manual in 1973, after an increasing number of studies showed that homosexuality is not, in fact, an illness.

The American Psychiatric Association similarly included “gender identity disorder” in its manual until 2013, when it decided that “gender nonconformity is not in itself a mental disorder.” “Gender identity disorder” was replaced with the term “gender dysphoria” in an attempt to simultaneously remove stigma associated with gender nonconformity and preserve treatment options for people who experience it.

The association’s inclusion of these terms in its manual was based on the presumption that LGBT people had a disease in need of a cure. While the removal of the terms has helped to alleviate some of the stigma surrounding LGBT people, healthcare discrimination is still experienced in many different ways, be it in receiving health services or trying to obtain health insurance.

Examples of LGBT people being treated disrespectfully are common in the workplace and in healthcare settings. The Center for American Progress reports that LGBT people often hide their sexual orientation or gender identity, or delay their gender-affirming transition in the workplace, seriously hurting their physical health. In addition, the Kaiser Family Foundation has found that LGBT people often hide their sexual orientation or gender identity from their own doctors—if they seek medical care at all. The National Women’s Law Center reports that healthcare discrimination can manifest in patients being verbally abused at the hands of doctors; some use harsh language toward them, some refuse to touch them, and others blame their patients’ sexual identity for their health status. Some doctors have even walked out on their patients in the middle of treatment. And so LGBT people are caught in a double bind: if they come out to their doctors, their doctors might discriminate against them, but if they hide their sexual orientation or gender identity from their doctors, their risk of receiving inadequate care skyrockets.

According to Lambda Legal, approximately 8 percent of LGB individuals and 27 percent of transgender individuals have been denied treatment to their faces. Some states have tried to increase those percentages. State legislatures in Michigan, Oklahoma, and Texas, among other states, have recently proposed discriminatory legislation—often named “religious freedom restoration acts”—that would allow people to discriminate against LGBT people on the basis of religious freedom. On the East Coast, Maryland’s governor, Larry Hogan, has withdrawn an amendment that would outlaw LGBT discrimination at the hands of Medicaid providers within the state. Meanwhile, as the Kaiser Family Foundation reports, LGBT people continue to be enrolled in Medicaid—or be completely uninsured—at higher rates than the average American.

For many LGBT Americans, just getting steady health insurance, let alone staying healthy, is an uphill battle. Sabrina Hernandez has climbed entire mountains trying to get consistent health insurance for her former partner and herself. Her former employer allowed her to add her partner to her health insurance plan after they got married in San Francisco. But the next year, “they explained to me that I could no longer cover her on my insurance. She was hearing-impaired and was having a lot of back issues. That year the company expressed that they would be trying to find an insurance carrier that would cover all their employees and their families. Yet, the following year, still nothing. I fought for three years with that company to get the coverage back, and nothing. The final year before I quit, I was informed that I could no longer put her on my life insurance as my spouse.” And after joining another company, Hernandez had the same problems as before.

About her ordeals, Hernandez says, “They should have never put her on to begin with if they were just going to remove her. That’s the mistake we make in saying that it’s okay for others to have what we don’t. It’s not.”

Indeed, many LGBT Americans lack the things that other Americans take for granted about their lives: laws protecting against workplace discrimination, the right to legally marry and receive spousal benefits at work, laws protecting their rights to adequate housing, and so on. The discrimination LGBT Americans receive at the hands of society only augments their healthcare disparities: they are more likely to suffer chronic conditions and disabilities and have higher rates of HIV/AIDS, mental illness, substance abuse, and sexual and physical violence than their straight, cisgender counterparts.

Januari Leo, public affairs field specialist at Legacy Community Health Services, says that healthcare providers “should be trained and cognizant about health disparities that the LGBT community faces” to prevent discrimination from occurring. The Kaiser Family Foundation reports that most medical schools don’t teach students about treating LGBT patients, even though organizations such as the American Medical Association and the American Association of Medical Colleges have stated their support for reducing LGBT health disparities and discrimination.

Doctors’ lack of education and acceptance when treating LGBT patients can manifest in many ways. Both the National Center for Transgender Equality and the National LGBTQ Task Force report that 50 percent of transgender Americans have had to teach their own doctors about how to treat them.

In other cases, it’s more personal. Carmen, who identifies as pansexual and requested to use a pseudonym, says that her doctors have often asked her intrusive questions while treating her, making her feel “really uncomfortable. I didn’t feel accepted; I felt tolerated.” She says that “there is a huge need in the medical community for education around LGBT issues.”

LGBT healthcare providers also experience discrimination. Roy Trahan, who has served as a nurse in various Houston-area hospitals, reports that patients refuse healthcare from LGBT doctors for irrational reasons. “One situation arose in the emergency department when I was working as a triage nurse,” Trahan says. “A patient arrived by ambulance and had been assaulted in his garage with a golf club. He had a huge gash in his forehead. I began to ask medical questions, and when I asked to measure the size of the gash, the patient jumped off of the ambulance stretcher and said he did not want me to touch him because he might get AIDS. He then ran out of the ER and disappeared.” Trahan says he felt upset that this type of bigotry would cause patients to refuse treatment from gay medical professionals altogether.

Ciandra Jackson, who serves as director of communications at Legacy, says that “the main things” that doctors should do to better serve their LGBT patients are to learn about how to treat LGBT patients and to become more accepting of them in general.

Colt Keo-Meier, a local consultant on LGBT health, says that doctors “need to commit to our promise of ‘doing no harm’ [which is the Hippocratic Oath], and use it with all patients, including LGBT patients.” Many doctors of LGBT patients end up doing the exact opposite of what they’re supposed to do, harming them instead of healing them. “[My patients] have been told that they should try not to be LGBT. They have been instructed to pray to change themselves. They have been questioned as to why they would even want to start a family. They have been told that they are sexual predators, unworthy of the love they desire, and unsafe around children. They have been told that they are sick, perverted, depraved, beyond salvation, and will not be able to maintain a healthy relationship. These messages do tremendous harm, increase disparities in patients’ health, drive patients to use substances to cope, and contribute to thoughts of suicide.”

Studies exploring LGBT health disparities and discrimination tend to underreport the discrimination and disparities LGBT people can face. Liz James, CEO of the Lesbian Health Initiative (LHI) says that many LGBT people are reluctant to respond to research studies about their health for fear of repercussions against them as a result. James views the chance to respond to such studies as a positive. “If we don’t answer these questions, we aren’t going be seen, and the only way we are going to address discrimination is to be seen in data sets,” she says. “The story is, we have the power to fix it.”

But beyond the need to participate in surveys, James says the LGBT community needs to “enroll in healthcare coverage” and use the healthcare services provided to them. State lawmakers could make this process much easier for everyone involved, James says, by expanding Medicaid. “As many as 41 percent of the uninsured LGBT community does not have access to health coverage through the Marketplace because they are at or below 139 percent of the federal poverty level.”

The important thing is that LGBT Americans step up and address discrimination head-on, James says. “LGBT [Americans] can and must be a part of making these rights, these protections, visible and real for themselves, their families, and their communities. Our health—the health of our families and our communities—depends on it.”